This is not your typical blog. We have recruited scholars and public policy analysts from around the world to provide daily news and commentary on the implications of bioethical issues for women. We hope you’ll bookmark this page and let us know what you think: just click on the comment link at the bottom of each post to join the discussion. To sign up for the WBP newsletter, visit our homepage at www.womensbioethics.org or follow us on Twitter at http://twitter.com/khinsch

Disclaimer: The opinions expressed on this blog are solely those of the individual contributors and do not necessarily reflect the official policy positions of the Women's Bioethics Project.

Saturday, March 31, 2007

A few months ago, we wondered at the wisdom of going ahead with uterine transplants without doing those simple things like animal trials, seeing what the risks of anti-rejection drugs are on a pregnancy, and how a transplanted uterus would hold up during the duration of a pregnancy. (For example, would a transplanted uterus maintain the necessary elasticity to grow during pregnancy? Would the sutures maintain the bond between uterus and blood vessels?) Without answers to these and other questions, we remained skeptical of the entire concept.

Well, researchers in Sweden have apparently decided animal models would be a swell idea, and have done auto-transplants on 14 ewes. In this procedure, their own uteruses were removed, left out of the body for several hours, then re-transplanted into the body and grafted onto a different blood supply (one providing blood to the legs). Half the sheep developed complications that required euthanization (ewe-thanization?). Of the remaining seven, five were mated naturally and four became pregnant. These ewes are nearing the end of their gestation, at which point the researchers will perform c-sections to deliver the hopefully healthy lambs.

Of course, these are auto-transplants - a good first step to figuring out the complexities of uterine transplants as a whole. Right now the researchers just have to worry about getting the re-implanted uterus working; anti-rejection drugs and their effects on pregnancies can come at a later (planned) stage.

While the New Scientist article wants to warn of the dangers of and inherent risks to non-necessary surgery, I think we're well beyond that. We're a nation of people who take that risk daily, going under the knife for vanity surgeries to fix purely cosmetic issues. Given the huge import placed on bearing biological children, uterine transplants aren't going to be stopped by someone saying it might be dangerous, and the attitude that it's a non-necessary surgery, when biological children are so valued, is just going to offend what I suspect will be a large number of women who would leap at the chance, should technology allow.

(With apologies for the puns. I think Art Caplan is rubbing off on me...)

There's also a supplemental interview (free) on the topic with Emily Galpern, project director on reproductive health and human rights for the Center for Genetics and Society in Oakland, California and Debora Spar, a professor of business administration at Harvard Business School, Boston. http://content.nejm.org/cgi/content/full/356/13/1289/DC1

The key question here is whether it's ethical to pay women for eggs that will be used for reproductive purposes but not pay them for eggs used in stem cell research - creating two different economic markets in the process, each with very different incentives and outcomes. See what you think!

Tuesday, March 27, 2007

WASHINGTON -- A powerful podium like Tony Snow's and wealth like Elizabeth Edwards' mean nothing to cancer cells. A disease that afflicts the comfortable along with everyone else, cancer casts a large shadow in this presidential campaign, and now in the White House.

The back-to-back revelations that President Bush's spokesman and the wife of Democratic presidential candidate John Edwards are battling recurrences of cancer have resonated not just in living rooms, but high places, too.

*Many thanks to the Consulate General of Romania in NYC which offered the unusually delightful venue for our reception.

The 2007 conference “Human Rights for the 21st Century: Rights of the Person to Technological Self-Determination” will focus on (a) human rights in the context of bodily autonomy as well as reproductive and cognitive liberties, (b) emerging biotechnologies which may contribute to the exercise of such rights, and (c) challenges to the ideas of human identity underlying some human rights discourse.

The conference will address the role of emerging technologies and scientific progress in today's society, as well as their implications for humanists and bioethics. Potential topics to be considered include nanotechnology in medical treatment, novel vaccines against addictive behaviors, internet-enabled social networking and engineering, designer genetic engineering, novel transplantable tissue and organ generation, neuroscience, as well as emerging technologies and women’s rights.

Paper presentations, for panel discussions, are welcome. The extended deadline for the submission is April 25, 2007 (12-15 pages). Accepted papers will be peer-reviewed and considered for publication in the Journal of Evolution and Technology(http://jetpress.org). Online registrations will be also available for those unable to attend the Conference (for those wishing to submit a paper for review and possible publication).The address for the submission of papers, registration fees (by check, payable to “IHEU”) or inquiries:IHEU, P.O. Box 4104 Grand Central Station New York, NY 10162

Phone: (212) 687 3324 Email: analita@iheu.orgOr by Paypal (online) to http://ieet.org/index.php/IEET/rights2007Registration forms and other details will be posted on:http://www.iheu.org/bioethics and at http://ieet.org/index.php/IEET/rights2007

Last weekend's Sunday New York Times had this long article about Katharine Moser, a 23-year-old woman with a family history of Huntington disease. Huntington disease (HD) is a hereditary, adult-onset, progressive neurological disease. It's autosomal dominant, meaning that you need only one abnormal gene (of the pair each of us has, one from mom and one from dad) to develop the disease.

While working in a facility that provides care to HD patients, Ms. Moser learned that a genetic test was available that would tell her whether she has the disease-causing mutation. Deciding that knowing was better than wondering, she chose to be tested. The news was not good.

The article is very interesting and does a good job of explaining how heredity works in the case of HD. Ms. Moser's struggle to incorporate this new knowledge into her life is moving, and her efforts to promote awareness of HD and garner support for research are impressive.

As more genetic tests become available, more of us will face similar choices. If you could find out your risk of developing a debilitating disorder for which no cure is available, would you want to know? Who else would you want to have this information? Friends? Family members? Some but not others? What about prospective employers? Your insurance company?

The question about who should know brings up a piece of Ms. Moser's story that receives what seems to me to be insufficient attention in the NYT article. That is the fact that Ms. Moser's mother had chosen, for herself, not to be tested. She did not want to know whether she would develop the disease that she had seen ravage her family members. She would deal with it if it happened, but she did not want to know ahead of time. Ms. Moser's test result removes any doubt, however: if she has the mutation, so does her mother.

Should this have made a difference to Ms. Moser's choice to "go public" with her story? Should it have affected the journalist's approach? The NYT's decision to publish these details as part of a front-page article, complete with a pedigree (diagram) of the family? If so, how? It not, why not?

Kelly Hills (a/k/a Buddhist Valkyrie) had this quote on one of her emails and I thought I had to share this with our readers -- I love watching Grey's Anatomy and House, MD, but I have to admit that the lack of consideration of ethics in both shows make me cringe -- In fact, I was telling one of my colleagues that watching House, MD is a bit like rubbernecking a car crash scene -- it's awful, but you can't look away. I play clips to my students to portray how NOT to handle certain situations.

Still, I wonder when either of these shows will get around to hiring a gorgeous actor or actress to play the first TV bioethicist -- hmm, since they're running out of rhymes for McSteamy or McDreamy, they'll have to think of something else...like McEthical? Or maybe it'll be on the Grey's Anatomy spinoff with Kate Walsh.

But seriously, (yes, SERIOUSLY), if you're interested in media/television and their responsibility to portray medicine/ethics properly (or their utter lack of doing so), you might be interested in the following call for papers:

Sunday, March 25, 2007

I'm a recent regular reader of your blog and thoroughly enjoy it. Every post is food for thought and discussion. I appreciate that you and your bloggers have created a place to gather together news and articles that highlight the bioethical issues that specifically affect women. I do, however, have one concern (on your behalf) -- that is the amount of text some of your bloggers copy and paste from their sources and lack of clear attribution. It is frequently confusing as to where a quoted article leaves off and where the bloggers comments begin...I'm not trying to be pedantic or critical here. Just cautionary. You folks are doing an incredible job!

Carry on, -K~

***********************Fellow bloggers, please be sure to use the blog quote feature when citing another person's work. It will help our readers know when the cited work ends and our own voice begins. Thanks to reader -K~ for her kind works and helpful suggestions.

[Thanks to Karama Neal for this entry!]STORIES THAT BIND, STITCHES THAT HEAL

This presentation will explore the relationship between quilting, an enriched group process, and the emergence of a community narrative concerning a traumatic community experience, the U.S. Public Health Service Syphilis Study. Using the framework of occupational science, the academic discipline that informs occupational therapy as a profession, the relationship between engagement in meaningful activities, health and well-being is explored. The project is collaboration among 15 African American women, between the ages of 55 and 95 years, who attend a local community center and the Occupational Therapy Program at Tuskegee University. Incorporating an enriched group process described as occupational form, the pre existing physical elements & social cultural contexts that elicit, guide, or structure human performance (Nelson 1988 p. 21), is instrumental in revealing important clues about the projects potential as a catalytic tool for community outreach, public conversation, and education. Moreover, as a result of this engagement there are strong indications that health related benefits are also possible. Quilting is a most appropriate occupation (meaningful activity) to use with African American women because of the social, cultural, and personal meanings and metaphors inherent in the activity (Fidler, 1999 p. 3).

Like the multiple textures of a quilt, this inquiry project has multiple themes and objectives. From the perspective of the participating women, it seeks to "patch" together stories in an effort to understand the legacy of the syphilis study, and the biopsychosocial impact it had, and continues to have on the lives of women, families and the community as a whole. In the vernacular of African American quilting the term "patch," remnant pieces of fabric or those extracted from old clothes and sewn into squares, is used as a metaphor for stories being told, hence; "stories that bind, stitches that heal." Patch one of the project represents the central motif and provides a rich description of the project, its qualitative design, objectives, and methodologies. Patch two discusses what was learned from the project, its• socially constructed-meaning, as well as the expressed hopes and aspirations of the participants.

Saturday, March 24, 2007

Dr. XX: “Okay, I am ready for the line-up. Make room and send in the genes at once!”Lab assistant XY: “Genes, front and center! Take your places next to the glass. Dr. XX will be looking closely for suspects and we have reason to believe that many of you are highly influential delinquents.”

*****Suspect genes beware! New evaluation methods may identify your defiant ways long before you have time to act, conspire with environmental cronies, be influenced, or influence other genes, and before you harm the body that shelters you. Akin to criminal profiling, suspect genes will be “tagged,” put up against the “glass,” and examined closely all with the hope that they do not further express themselves and contribute to negative behaviors including substance abuse and personality disorders.1

Gene-based profiling has been used to predict and diagnose certain diseases and to tailor treatment approaches. However, these tests may be taken to another level: to identify persons more likely to become dependent on nicotine or marijuana or more susceptible to personality disorders. In the future, expressed genes may take the rap way before a person physically and negatively expresses him/herself. As described in a recent online news article, recent reports indicate that genetic tests similar to those used to manage diseases may be employed to determine those who have a greater biologic basis for engaging in substance abuse or who are prone to personality disorders.1

Data from Robert Philibert, MD, PhD (University of Iowa Roy J and Lucille A Carver College of Medicine), and colleagues suggest that gene expression in blood may determine if a person is susceptible to behavioral disorders. Yet simply having a particular gene expression alone does not predict that an individual will act in a certain manner. According to Dr. Philibert, what is paramount here is not “gene possession” but rather if the target gene is expressed and the possible influential environmental factors at work. Using samples from 6 subjects from the Iowa Adoption Studies and 9 controls, a technique termed “transcriptional profiling” was performed to examine blood. This lab method evaluates all the genes in the blood (almost 30,000) at one time. All expressed genes are labeled with fluorescent tags and changes in intensity of fluorescence are used to identify differential gene expression. Patterns of genes for specific diseases are then mapped and defined over time. Data from 94 adoption study subjects were use to identify gene pattern matches.1

The bioethical sides of our brains have to be jumping at this point. For starters, scroll back up to the opening script and replace “Dr. XX” and “Lab Assistant XY” with “Detective RNA” and “Sargent DNA”, respectively, and replace “genes” with “detainees.” Will we eventually be judged by our genes? Will employers, insurance carriers, and healthcare workers discriminate against those who have greater risk for personality disorders or substance abuse? What type of investigations will unfold when certain parties have this type of information? Are there ways to optimize the positive advantages of these types of gene-based tests while negating the negative consequences? For the bearer of “bad genes,” who will soothe their restless minds, educate them about testing methods (and their limitations), and offer preventative strategies just in case they end up in a compromising scenario and give in to temptation?

One of the study coinvestigators added that, “Just because we can look at the deep biology of the individual doesn’t automatically mean negative outcomes will follow.”1

I am going to hope for the best: additional and more thorough investigation of gene-based tests, making testing optional, conducting/using tests in an appropriate fashion, and holding results in the strictest confidence.

Friday, March 23, 2007

"I informed a patient's parents that we would call them when their child was off the heart bypass machine and back in the intensive care unit. That went down like a lead balloon as the child was in fact having spinal surgery. Oops...." (From http://mediblogopathy.blogspot.com)

An article in the Washington Post today examines the troubling trend of doctors blogging about their patients (sometimes rather harshly and crudely). The phenomenon is so new that medical boards, schools and professionals disagree on what is acceptable. The trend is troubling because not only because of the risk of compromising patient privacy but also because of potential liability for hospitals. I certainly could envision lawsuits -- can't you just see the latest lawyer ads? (Is your doctor talking about you behind your back? Dial 1-888-SueTheBastards or visit our website at www.SueTheBastards.com!)

Artist Justine Cooper has a sideline: drug development. She also handles all marketing for her invention, the new blockbuster medication Havidol. Check out the website: it's a provocative (and amusing) commentary on the medicalization of discomfort in America.

Joking aside, there are some serious ethical questions here. Drugs are available now for a range of "syndromes" and "disorders" that used to be considered part of life. Not our favorite part, maybe, but not the end of the world. Today there are medications for Restless Leg Syndrome. Some argue that many little boys who are being given drugs for Attention Deficit/Hyperactivity Disorder are, in fact, healthy little monsters whose unruliness is developmentally appropriate. Treatment is also available for Idiopathic Short Stature.

Where should we draw the line? Is medicalizing such "disorders" beneficial to patients? Or mainly to pharmaceutical companies? And which came first: the drug or the disorder?

Hint: the site is a bit like the Harry Potter books. . . try saying the unfamiliar words out loud.

The Women's Bioethics Project is holding a special "honor our bioethics mothers" campaign - where would we be without them? We don't want to give away the details just yet (surprise!) but we are soliciting nominations from our bloggers and blog readers. Who are the women you admire for the contributions they have made to the field of bioethics? Please send your nominations (including name of the nominee, why she should be honored, and her contact information) to khinsch (at) womensbioethics.org by April 15th. Winners will be announced and honored in May.

Wednesday, March 21, 2007

We have upgraded to the new blogger software and changed our look and feel. Tell us what you like and dislike about the new format and template. We don't think we have it quite right (orange fonts?) Thanks.

Monday, March 19, 2007

With the number of caregivers for frail elderly people set to fall steeply, researchers in this week's British Medical Journal propose a way to help plan for the deficit.

Many people fear that population ageing will generate a demand for long term care that will outpace the supply of formal care. So to anticipate the future long term care needs of the oldest people, researchers in Switzerland suggest introducing the "oldest old support ratio."

Their ratio is based on four age groups - the young, those of working age, younger retired people (aged 50-74), and the oldest people (aged 85 and over) - and provides information on the number of people potentially available to care for one person aged 85 or over.

Based on current trends, they estimate that the young retired generation will have to play a greater caring role in the future.

The number of kidneys, livers and other body parts surgeons are harvesting through a controversial approach to organ donation has started to rise rapidly, a trend that is saving the lives of more waiting patients but, some say, risks sacrificing the interests of the donors.

Under the procedure, surgeons are removing organs within minutes after the heart stops beating and doctors declare a patient dead. Since the 1970s, most organs have been removed only after doctors declared a patient brain dead.

Federal health officials, transplant surgeons and organ banks are promoting the alternative as a way to meet the increasing demand for organs and to give more dying patients and their families the solace of helping others.

Some doctors and bioethicists, however, say the practice raises the disturbing specter of transplant surgeons preying on dying patients for their organs, possibly pressuring doctors and families to discontinue treatment, adversely affecting donors' care in their final days and even hastening their deaths. For more, click here.

Women's groups and members of Congress late Friday celebrated a decision by the Food and Drug Administration to fully fund the agency's Office of Women's Health.

Last month, agency insiders leaked information indicating that FDA Commissioner Andrew C. von Eschenbach had devised plans to reduce the office's fiscal 2007 budget by about 25 percent -- a cut that advocates said would have effectively suspended the office's activities for the rest of the year.

During the past week, activists and several members of Congress repeatedly pressed von Eschenbach about the pending move -- and until Friday the commissioner said he had not made up his mind. But late that day the agency released its long-awaited 2007 operating plan, which funds the office at the same $4 million level it has had for several years.

"It is disappointing that on the important issue of women's health, FDA had to be persuaded to simply maintain the funding level that was requested by the administration and provided by Congress," said Rep. Rosa DeLauro (D-Conn.), chairman of the House appropriations committee that funds the FDA.

At the same time, she said, "It is very gratifying that the FDA reversed course."

The office funds research on biological and other differences between men and women that can affect the diagnosis and treatment of diseases in women. To read on, click here.

The Union Pacific Railroad Company did not discriminate against its female employees by excluding birth-control pills from its health insurance coverage, according to a federal appellate panel in St. Louis.

In the first federal appellate ruling on the issue, the United States Court of Appeals for the Eighth Circuit ruled 2 to 1 on Thursday that because the railroad’s health insurance plans did not cover any types of contraception, for men or women, it did not violate the Pregnancy Discrimination Act, part of the federal law forbidding discrimination in employment.

“Union Pacific’s health plans do not cover any contraception used by women such as birth control, sponges, diaphragms, intrauterine devices or tubal ligations or any contraception used by men such as condoms and vasectomies,” the opinion said. “Therefore, the coverage provided to women is not less favorable than that provided to men.”

[Editor’s note: it is hard for me to imagine an HMO/MCO not including birth control pills except on an ideological basis.Especially when they provide Viagra]

March 19 (Bloomberg) -- Elias Zerhouni, director of the U.S. National Institutes of Health, said ending the Bush administration's restrictions on the use of human embryonic stem cells would benefit medical research in the U.S.

``The current lines will not be sufficient,'' Zerhouni said today at a Senate hearing on funding for the NIH. ``It's not possible for me to see how we can sustain the momentum of research.''

President George W. Bush has banned federal funding for studying all but a limited number of embryonic cell lines and last year used the only veto of his tenure to defeat a bill that would have overturned his restrictions. The comments by Zerhouni, in response to questions at the hearing, were his most direct criticism of the current stem-cell policy.

``It's clear that American science and the nation will be better served if we have access to more cell lines,'' said Zerhouni, who was appointed by Bush to head the NIH in 2002.

Senator Tom Harkin, an Iowa Democrat, asked Zerhouni, whether lifting the restrictions would have an effect on finding new cures.

``The answer is yes,'' Zerhouni said. The exchange came at a hearing of the Senate Appropriations subcommittee on Labor, Health and Human Services and Education.

Sex selection is 'playing God' and since western democracies are built on the separation of church and state, if sex selection is against ones religious belief they can refrain from it.

Sex selection is 'playing mother earth' and therefore it is 'unnatural' however on the basis that something is natural or unnatural doesn't make it moral or immoral. Dahl gives the example of heart transplants being 'unnatural' but not immoral.

Sex selection is using medical procedures for non medical purposes but we've crossed that boundary ages ago with plastic surgery being used for cosmetic purposes.

Sex selection wrongly allocates limited medical resources but since western societies are run on private economies based on free and open markets, resource allocation is not an issue.

Sex selection distorts the natural sex ratio leading to imbalances as seen in India and China. Dahl maintains that since western societies do not have marked preference for one sex over another we will not be at risk for imbalances in sex ratios.

Sex selection distorts the natural birth order leading to a society of first-born 'son and heir'.

And Sex selection creates a society of 'little sisters' since girls will be desired after the first born son. Dahl combines his argument against reasons 6 and 7 maintaining that "it is highly unlikely that hundreds of thousands of couples would employ sex selection technology for their first child to be a boy" and second born children do not feel second best so there will be no harm to our sons and daughters by ordering their birth.

Sex selection is sexist but Dahl states that parents do not view one sex as more valuable than another but use sex selection out of a desire to have children from each sex.

Sex selection negatively impacts the welfare of the child by imposing gender specific behavior on that child. Dahl insists, couples who use sex selection want a girl, not Angelina Jolie or they want a boy, not Brad Pitt.

Sex selection leads down the slippery slope of designer babies. But since this is not an argument against sex selection per se, but of the consequences of sex selection, Dahl feels optimistic we can manage these desires and "draw a legal line permitting some forms of selection and prohibiting others."

I have yet to hear an ethicist who is a woman come forth in support of sex selection; part of it, I think, it is that it wasn't that long ago that the women were considered mere property... it wasn't all that long ago that the expression "rule of thumb" referred to the circumference of the stick that a husband could beat his wife with... it was only 1920 that women could finally vote...Dahl misses two major points: first, he is forgetting the history of women, not just in western society, but all over the world and secondly, he dismisses attitudes in India and China as insignificant or not having an impact on the rest of world. In this day and age, in this global economy, in this shrinking world, we can neither afford to ignore history nor stick our heads in the sand and pretend that one part of the world is somehow isolated or insulated from other other parts of world. The United Nations recognizes that sex selection, in most parts of the world, reinforces the devaluation of women.

Because the patient is entitled to all personal medical information, including the sex of the fetus, it might impossible for health care professionals to avoid unwitting participation in sex selection, but it would send a strong and clear message if laws were passed that prohibited sex selection except for the purpose of preventing serious sex-linked genetic diseases.

[Editor's note: One of the readers asks what message we send our disabled friends by permitting sex selection for serious genetic defects -- my intent is not to devalue the disabled, but to prevent unnecessary suffering. I acknowledge, though, that is an area fraught with difficulties -- see the editorial by Dr. Colin Gavaganh (Embryo testing: Why drawing lines risks devaluing the disabled). I also think philosopher Rosamond Scott has some interesting things to say about this in her article Prenatal Testing, Reproductive Autonomy, and Disability Interests: ... "the language of 'suffering' may be of particular concern to people with disabilities, at least in that it may make presumptions about, rather than listen to, their views. This again highlights the importance of careful reflection about whose interests may be truly or most at stake in prenatal screening, PGD, and associated selection decisions. The pressing issue in relation both to parents’ interests in making reproductive decisions as well as to the interests of those with impairments is how best to enhance the deliberative processes attending these reproductive decisions."]

Monday, March 12, 2007

When reviewing the various benefits packages for jobs I was recently applying to, I was surprised to discover that one company offered employees' pets full medical insurance coverage. Considering the pricey veterinarian visits for my new puppy, health insurance began to seem appropriate for him as well. Little Poochini insists on continually being the center of attention, requires a special diet, and is known to bark until his demands are satisfied. His playful disposition and constant presence lead me to forget that he is not an actual person; I think of him more as a little boy than a pet sometimes.

A week ago Poochini had a urinary track infection, which required antibiotics to be crushed in his food twice a day. In the past several months, he has also been to the vet more than I have been to my primary physician over the past several years. Are we beginning to place the health of our pets at a higher priority than the medical care we seek for ourselves?

Apparently in 2005, over two billion dollars of American spending can be attributed to pet medications (1). Many households have made desperate financial sacrifices to ensure that their pets receive the best available healthcare, regardless of what that may entail (1). Some pets undergo several courses of chemotherapy because their owners are hesitant to put their cherished loved ones to sleep. New drug developments by pharmaceutical companies and subsequent approval by the Food and Drug Administration has enhanced the number of available pet medications currently in circulation (1).

I think we sometimes procrastinate when it comes to addressing our own health needs. Then suddenly when we think our pet might be ill, we are anxious to run our pet to the veterinarian immediately. In kindergarten, I also recall that putting our family dog to sleep proved almost as devastating as the loss of a close family friend!

Should pets undergo intensive treatments and medical interventions like chemotherapy or be put to sleep? Are our pets sometimes subjected to unnecessary suffering because of our selfish desires to prolong their lives as long as possible? Does the development of new pet medications significantly interfere with medical research for humans?

At a time when the nation is pondering how to provide medical coverage to some 47 million uninsured Americans, it is logical and right to start with the country’s nine million uninsured children. The Bush administration, unfortunately, is going in exactly the opposite direction.

In a shortsighted effort to save money and promote its free-market philosophy, it has proposed reducing the federal contribution to a highly successful children’s health insurance program operated by the states. Democratic leaders in Congress are planning to respond with bold, and necessary, proposals to cover a large chunk of the nine million uninsured children — at a cost that could reach $50 billion to $60 billion over five years. To read more, click here.

As I am feverishly working on a supplemental manuscript on gram-negative bacilli and their increasing resistance to broad-spectrum antibiotics used in the critically ill with nosocomial infections, I stumbled on an enlightening article (see: http://news.nationalgeographic.com/news/2007/02/070206-skin-microbes.html) about the diverse coat of microbes blanketing our most outer regions.1 Bacteria and their treatments have always reminded me of the colorful and ever-changing world of fashion. Scientific article with titles such as “The New β-Lactamases,”2 “Emerging Bacterial Enzyme Targets,”3 and European “Trends in Ventilator-Associated Pneumonia”4 bring to mind sleek pneumococcal organisms modeling their finest, evolutionary genes in late summer for the masses to adopt during the subsequent winter season. As microorganisms change over time, whether through resistance, changes in transmission, or natural selection; so do the types of treatments used to treat the infections they cause. Therefore, what is “in” this season with regard to pathogens and treatments in a given geographical region may be passe by next.

A recent study by Martin J. Blaser and other infectious disease researchers at New York University School of Medicine implicated >240 distinct microorganisms on the forearms of 6 healthy subjects. For each subject in this study, their “coat” of microbes appeared to be as unique as their sense of style and no 2 subjects had an identical matrix or “robe” of microorganisms. While some overlap of microbes existed among subjects, for the most part there was “tremendous variation” in the types of organisms. Furthermore, repeated tests demonstrated that subjects’ microbes change with time,1 akin to how our hair or clothing styles change from year to year (or season to season, that is…you should have seen my hair weave a few years back). By the way, does anyone still have those polyester tops, platform shoes, and bell bottoms stashed in their closets?

Changes in skin flora may be related a host of elements ranging from the type of fabric that brushes up against our skin to the chemicals in the shampoos and detergents we use. The big idea behind Blaser and colleagues research was to determine if there are specific skin microbes associated with inflammatory conditions (eg, eczema). Of course, improved understanding of skin flora will allow for the development of more effective therapies.1

So, each one of has our very own unique “robe” of microbes that alters with time. As a lifelong sufferer of eczema and psoriasis, I look forward to additional exploration of these pathogens and their effects on inflammatory conditions. As an aside, beyond the apparel we don and the numerous products we lather on our skin, my gut is telling me that diet, stress, pollution, medication, and other environmental elements also influence our “microbiologic sense of fashion” at any given season. Lastly, while I feel that there are some individuals with skin conditions that necessitate pharmacotherapy, there are probably less potentially toxic methods to consider. Perhaps some day our decendents will read about our microbial fashion sense and grimace. How fascinating it would be to have Marie Antoinette’s “coat of microbes” to analyze and critique today!

Rhiannon M. Noth was denied Medicaid for heart surgery for her son Landen, 3, right, because she could not obtain the necessary documents.

From the NY Times this morning:

A new federal rule intended to keep illegal immigrants from receiving Medicaid has instead shut out tens of thousands of United States citizens who have had difficulty complying with requirements to show birth certificates and other documents proving their citizenship, state officials say.

Florida, Iowa, Kansas, Louisiana, New Mexico, Ohio and Virginia have all reported declines in enrollment and traced them to the new federal requirement, which comes just as state officials around the country are striving to expand coverage through Medicaid and other means.

Under a 2006 federal law, the Deficit Reduction Act, most people who say they are United States citizens and want Medicaid must provide “satisfactory documentary evidence of citizenship,” which could include a passport or the combination of a birth certificate and a driver’s license.

Some state officials say the Bush administration went beyond the law in some ways, for example, by requiring people to submit original documents or copies certified by the issuing agency.

“The largest adverse effect of this policy has been on people who are American citizens,” said Kevin W. Concannon, director of the Department of Human Services in Iowa...to read on, click here.

Professor Randall will lead a discussion on her newly released book, Dying While Black, which, in the words of one reviewer, "produces the 'smoking gun' connection between white privilege, racism, slavery and Black health outcomes." Professor Randall is a provocative and bold speaker whose controversial views should provoke an important and interesting conversation.

After lives in which they often struggle to get medical care, African Americans and other minorities are more likely than whites to want, and get, more aggressive care as death nears and are less likely to use hospice and palliative-care services to ease their suffering, according to a large body of research and leading experts. To read on, click here.

Friday, March 09, 2007

Several newssources are reporting that Poland is launching a fertility drive aimed at increasing its shrinking population. Poland ranks at the bottom of the EU's birth rate of 1.22 children per women, and some analysts suggest that by 2030, there will be four million fewer Poles, leading to economic disaster and worker shortage.

Now you would think that, as a very Catholic country, family would be incredibly important. In fact, having a family does consistently rank as one of the most important things in the lives of the Poles, er, poled. So we have a very Catholic, pro-family country with a rapidly declining birth rate - obviously there's an issue somewhere. As it turns out, that issue is in how Polish women are treated in the workplace. A majority of women are afraid that they'll lose their jobs if they have children, and in the economically depressed region, everyone needs to work.

Joanna Kluzik Rostkowska, deputy labour minister, has announced a series of plans aimed at addressing the discrimination women face in their work environments, including increasing maternity leave, extending opening hours for kindergartens and introduce tax breaks for families with children. And there's precedence for this - fifteen years ago, France instituted similar work policies for similar reasons, and today has the highest birth rate in the EU.

Maybe it's just my jaded American attitude talking, but it seems to me that this is just sensible policy to have in place. And admittedly, I thought it was telling that my reaction to the idea of "pro-family policies" was to think they were going to be encouraging women to stay home and bear children, rather than working to create better working conditions.

Thursday, March 08, 2007

From our blogger-scholar friend Sean Philpott. He is the Policy and Ethics Director of the Global Campaign for Microbicides, a broad-based, international effort to build support among policymakers, opinion leaders, and the general public for increased investment into microbicides and other user-controlled prevention methods. Dr. Philpott shares his thoughts on the recent microbicides trials:

Interventional studies designed to test new methods of preventing HIV transmission, such as microbicides, present a variety of ethical challenges. Researchers must ensure that locally acceptable means of preventing HIV and other STDs are available to all people who are screened or enrolled. Researchers also have a moral responsibility to ensure access to high quality care to all participants who seroconvert during the course of a trial.

When an prevention trial fails, as recently happened with Phase III trials of the candidate microbicide Cellulose Sulfate (Ushercell), researchers and trial sponsors are often accused of treating volunteers as guinea pigs. Worse yet, researchers may have to combat such rumors as the long-lived myth that participants are encouraged to have unprotected sex or deliberately exposed to HIV. At least two South African politicians have suggested precisely that. If anything, however, these two microbicide trials appear to be models of how transnational HIV prevention research should be conducted, through transparency and prioritization of participants’ rights.

In the CONRAD-sponsored Ushercell trial, 35 of 1,333 participants in both the experimental and the control groups seroconverted before the trial was discontinued. The rate of seroconversion was no greater than expected for at-risk women in these countries (48% of South African volunteers were found to already be HIV positive). There was, however, a slight increase in the rate of seroconversion in the experimental group. Although not statistically significant, researchers decided to stop the trial out of concern that Ushercell might increase risk of HIV infection. A second study, conducted at two sites in Nigeria by Family Health International, was also halted even though there was no evidence of increased risk. In all HIV prevention trials some volunteers will become infected despite the intensive counseling and support services they receive to help minimize their risk.

Contrary to what is being claimed by some politicians and journalists, however all study participants went through comprehensive informed consent procedures in their own languages, with key messages reinforced at every visit (including the fact that they should not count on the gel for protection and should always use condoms). All participants received monthly counseling, free condoms, and prompt diagnosis and treatment for any curable STIs. Trial sponsors also developed written agreements with local providers to assure that any women who seroconverted would get care, including antiretroviral drugs as needed; the CONRAD trial included a ”set-aside” in the research budget to support long-term care and treatment for participants.

Although disappointed by the results, leading microbicide and community activists like the Global Campaign for Microbicides and the African Microbicide Advocacy Group (AMAG) have been unanimous in their support of the Ushercell researchers, and continued microbicide research. These groups have been following the conduct of these studies, and have been directly engaged in the design, oversight and review of these and other microbicide trials.

Tuesday, March 06, 2007

This NYT article caught my attention over the weekend. I thought it offered an interesting perspective into the issues and risks surrounding multiple births from the perspective of the mother.

I went cold. “It’s triplets, isn’t it?”

“I’m so sorry,” the doctor said. “It is.”

My mouth fell open. My husband had to steadyhimself against the wall. There was no jumping for joy at the tiny heartbeats. I continued to stare in disbelief at the monitor. How could I possibly carry three babies to term in my 120-pound body? And what would happen if I couldn’t?

“Sometimes one or two of the fetuses can fade away after a fewweeks,” the doctor said. “But in your case, all three heartbeats are very strong. I think we need to talk about a reduction.”

“A reduction?”

“You need to consider reducing to one or two fetuses. In triplet pregnancies the babies often are born very premature with a lot of complications. You may be saving the lives of the other two by eliminating one.”

While I am a feminist who believes in abortion rights, this was not the choice I had in mind. To spend years and tens of thousands of dollars trying to conceive a baby only to end with discussions of an abortion seemed to me an especially cruel twist of fate. But what would we do if the triplets were born with serious handicaps? It seemed an impossible choice.

Monday, March 05, 2007

A new study is suggesting that the rapid rise in female early-onset puberty has to do with the BMI and amount of body fat in toddlers. The study followed 354 girls age 3-12 who were either normal weight, at risk of being overweight, or overweight, and found an association between elevated body weights and the early onset of puberty (determined by breast development and the onset of menstruation).

This link has been suggested before, but has always been a question of chicken and egg - was early puberty causing the obesity, or the obesity causing the early puberty? The PI for the study, Joyce Lee, says that by tracking the girls from such a young age, the "study shows that it is increased body fatness that causes the early onset of puberty and not the other way around."

Given what we know about the problems associated with precocious puberty, from later reproductive issues to more immediate concerns about the sexualization of a nine year old, this seems to justify further public health intervention in the obesity epidemic. Of course, the question becomes how to intervene. Is a ban on transfats going to solve the problem? Hardly. Bringing physical education back into schools, a opposed to once a week - if kids are lucky? Possibly. But without a radical overhaul of our diet, of how we eat, and what food is available at what price, I have a hard time imagining that the obesity epidemic and associated problems, are going away any time soon.

Sunday, March 04, 2007

The following article from the Washington Post describes the FDA's plans to approve the use of cefquinome, a broad-spectrum, powerful "last-resort"-type antibiotic, to help our poor cows recover from respiratory infections that are mainly caused by the poor living conditions imposed upon them by industry standards.

Never mind that there are several other antibiotics available and already on the market to treat these infections. Never mind that several panels of experts, including the American Medical Association and their own internal review panel, cried foul against cefquinome's approval.

Widespread use of cefquinome (yes, even in animals) will most certainly deal a potentially devastating blow to our ability to fight infections in humans. Decades of science, on top of recent evidence of advancing antibiotic resistance in pathogens, are behind the experts here. What's changing minds at the FDA? Well, they've gotta stand behind their new "guidance document"--the wording of which was apparently influenced by industry reps--which, according to the article, stays the FDA's hand unless they can show a direct impact of the drug on human mortality. Honestly.

Cefquinome is used in European livestock, and there appears to be some evidence that pathogens are developing resistance to this high power antibiotic:

Friday, March 02, 2007

The British government signaled that scientists will be allowed to create part-human, part-animal embryos for research into potentially life-saving medical treatments.

Caroline Flint, the health minister, is considering removing a ban on such work from a draft bill that will form the basis for new laws on fertility treatment and embryo research. Two teams of British researchers have applied for permission to create "cybrid" embryos that would be around 99.9 per cent human and 0.1 per cent rabbit, cow, pig, sheep or goat to produce embryonic stem cells – the body's building blocks that grow into all other types of cells.

They want to use the stem cells to understand and provide new treatments for diseases such as Alzheimer's, Parkinson's, cystic fibrosis, motor neurone disease and Huntington's. A draft bill to replace the Human Fertilisation and Embryology Act 1990 is currently being drawn up. It is expected to be ready in May and is due to be included in the Queen's speech in November.

A network of artificial nerves is growing in a Swiss supercomputer -- meant to simulate a natural brain, cell-for-cell. The researchers at work on "Blue Brain" in Lausanne, Switzerland (hmmm, sounds like the plot to "The Footprints of God"-- promise new insights into the sources of human consciousness.

This unprecedented piece of hardware consists of about 10,000 computer chips that act like real nerve cells. To simulate a natural brain, part of the cerebral cortex of young rats was painstakingly replicated in the computer, cell by cell, together with the branched tree-like structure of the synapses.

On the Internet, there is a virtual world called Second Life. It's not a game: no one wins, loses or dies. It's not a show: nothing happens here unless you make it happen.Second Life is all about wish fulfillment. You're represented by a computer-generated character. You can make it walk around. You can fly. You can exchange typed comments with other people's characters. You can make yourself young and beautiful. You can even make the sun set on command. (One of the more interesting ethical questions this poses is if you do a social experiment online, do you need to run it through an IRB and get the informed consent of the participants?)

The television spot shows a 40-year-old woman, in slow motion, as her family and co-workers rush by over the course of a day. It ends with her sitting alone, amid the remnants of a birthday party.

"The worst part isn't even that everyone thinks the problem's in my head," a female voice intones. "The worst part of chronic fatigue syndrome is missing my life."

The spot is the centerpiece of a remarkable $4.5 million public awareness campaign bankrolled by the U.S. Centers for Disease Control and Prevention. It's remarkable, in part, because of the role advocacy and politics played in creating it.

Chronic fatigue syndrome is not contagious or life-threatening, and medical skeptics continue to question its merits as a focus for public health. But the money is being spent, in part, thanks to strategic lobbying and congressional interest.

Indian Government To Open Orphanages for Female Infants To Reduce Sex-Selective Abortion, Official Says

In Medical News Today, The Indian government plans to set up orphanages in each regional district for female infants in an effort to curb sex-selective abortions, Renuka Chowdhury, minister of women and child development, said, the PTI/Hindustan Timesreports (PTI/Hindustan Times, 2/18). India in 1994 approved the Prenatal Determination Act, which bans the use of technologies such as ultrasounds and sonograms for the purpose of sex-selective abortion. The law also bans advertisements for prenatal sex determination, as well as the practice of preconception sex selection law. According to a UNICEFreport released in December 2006, about 7,000 fewer girls than expected are born daily in India, and about 10 million fewer girls than expected were born in the past 20 years.

When it comes to fertility and the prospect of having normal babies, it has always been assumed that men have no biological clock — that unlike women, they can have it all, at any age.

But mounting evidence is raising questions about that assumption, suggesting that as men get older, they face an increased risk of fathering children with abnormalities. Several recent studies are starting to persuade many doctors that men should not be too cavalier about postponing marriage and children.

Until now, the problems known to occur more often with advanced paternal age were so rare they received scant public attention. The newer studies were alarming because they found higher rates of more common conditions — including autism and schizophrenia — in offspring born to men in their middle and late 40s. A number of studies also suggest that male fertility may diminish with age.

Premature baby who had record survival may change view of unborn, specialists say

The birth and record survival of a baby less than 22 weeks gestation could have, and should have, an impact on the perception and treatment of unborn human beings, pro-life bioethicscommentators say.

Amillia Sonja Taylor, born at 21 weeks and six days, went home Feb. 21 weighing four pounds after a nearly four-month stay at Baptist Children’s Hospital in Miami, Fla. When she was bornOct. 24, she weighed less than 10 ounces and was only 9 1/2 inches long.

She is the first baby known to have survived after less than 23 weeks gestation, according to the hospital. Infants who go to full term are born between 37 and 40 weeks. The hospital reported the death rate for babies born at 23 weeks is 70 percent, according to the AmericanAssociation of Pediatrics.

An inquiry panel has found what it called “significantly flawed” data in a major stem cell paper published in Nature in 2002.

The article, which claimed stem cells isolated from an adult could change into all the major tissue types of the body, was seized on by opponents of abortion as showing that embryonic stem cell research was unnecessary since adult stem cells could provide all the predicted benefits.

An expert panel convened by the university concluded that a process used to identify the cells was "significantly flawed, and that the interpretations based on these data, expressed in the manuscript, are potentially incorrect."

Verfaillie, who has an international reputation in stem cell research, called the problem "an honest mistake" and said it did not affect the study's conclusions about the potential of adult stem cells.

But the disclosure comes at a time of growing skepticism in the scientific community about the power of this kind of adult stem cell, in part because others have had only limited success replicating her study.

Political ramifications

Verfaillie's research was heralded by social conservatives who have pinned their hopes on adult stem cells as an alternative to using embryonic cells, which they oppose on moral grounds.

At the same time, Verfaillie's work had cemented the reputation of the University of Minnesota as a major force in the world of stem cell research.

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